• COVID-19 Testing Registration Form

    COVID-19 Testing Registration Form

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              COVID-19 Rapid Antigen Test (Same-Day Results)Rapid Antigen Test,
              $50.00
                
              COVID-19 Rapid PCR Test (Same Day Result)
              $150.00
                
              Indicaid (Same-Day Results)Rapid Antigen Test
              $50.00
                
              Influenza A&B Nasal Swab Rapid
              $45.00
                
              Strep A Throat Swab Rapid
              $45.00
                
              Total
              $0.00
            • Consent for Testing:

              I understand and agree:

              I am consenting to receiving a point-of-care test with NuRx Pharmacy.
              No test is 100% accurate, and there is a chance that the results of the test may or may not accurately reflect my diagnostic status.
              I do not hold NuRx Pharmacy LLC or any employee or other representative of NuRx Pharmacy responsible for any consequence of a positive, negative, or inconclusive result.
              Due to the nature of point-of-care testing, there is a risk that I may be exposed to or infected by proceeding with my scheduled testing and hereby fully assume all risks which include without limitation, the need for additional testing, a positive diagnosis, required quarantine or self-isolation, hospitalization, treatment in an intesive care unit and intubation or ventilation support, death, and/or other medical complications.
              NuRx Pharmacy may have an obligation to report test results to governmental or other public health authorities pursuant to applicable law and regulations and I hereby consent to any such reporting by NuRx Pharmacy. 
              I acknowledge and agree to having my test results sent to me via text message. And also over email, if I request the official PDF result. I understand that this is considered Protected Health Information (PHI), and authorize NuRx Pharmacy to send it.
              In the event that my employer pays (whether directly or indirectly) for my test, then I hereby consent to NuRx Pharmacy disclosing the results of my test to my employer.
              Under no circumstance am I entitled to a refund. 
              I am expected to arrive on-time to my appointment.
              If I am late or miss my appointment, I understand that my test may not be rescheduled and I am not entitled to a refund.

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